Impact of a school-based shisha use prevention program in Qatar: A pilot study

Background: Shisha: a re-emerging type of tobacco use contains harmful substances. Around 21% of 7 to 9th Graders students (29%: boys and 15.4%: girls) smoke any forms of tobacco in Qatar (GYTS, 2007). The prevalence of shisha use at young ages is alarming and calls for immediate intervention. To date, and despite the increasing prevalence of shisha use among youth, and its documented health hazards, no intervention to delay or prevent initiation has been evaluated. As such, this study was conducted to test for the impact of a shisha prevention program on controlling use of shisha by 7th and 8th graders in Doha, Qatar. Significance: This is the first piloted school based intervention related to shisha smoking and hence results of this study are important for researchers in the field given the high increase in shisha use among youth in the region and worldwide. Methodology: The intervention was based on the Health Belief Model and the Theory of Planned Change as the theoretical models of health behavior and targeted 7th and 8th graders in both public and private schools in Qatar. The intervention consisted of 8 sessions. The 8 sessions were targeting knowledge, decision making skills/self-efficacy, refusal skills, media literacy around tobacco & social promise. Results: A total of 253 students took the pre-test with 146 and 107 students assigned to the intervention and control groups respectively. Overall, there was a significant increase in the total shisha knowledge score among the intervention arm but not among the control arm. In the intervention arm, there were significant increases in the percentage of students with positive responses towards 9 out of the 16 attitude statements. In contrast, in the control arm there were significant decreases in positive responses to 4 of the 16 attitude statements and only for one statement there was observed a significant increase in positive response. Conclusion: The study demonstrated the feasibility of doing such an intervention in schools in Qatar. The intervention succeeded in increasing knowledge and perceived severity of the hazardous effects of shisha use. The intervention succeeded in increasing knowledge and positive attitudes towards shisha use. This is very essential as a first step towards behavioral change especially in a subject (shisha smoking) where misconceptions among adults as well as youth are high.